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,■ RE.0 L..Ixv/E 10:16:23 a.m. 06-14-2017 1 /1 <br /> A DATE RECEIVED <br /> in JUN 14 2011' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> IE �x ENVIRONMENTAL HEALTH DEPARTMENT ��/l/r �� <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 / <br /> �VMNA&"�ti TAL 1'115*TFt Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.$)gov.org/ehd <br /> PENAITISURirCES PUBLIC RECORDS RELEASE APPLICATION UV <br /> I47-7 <br /> LY'c ��VC{ BUSINESS/AGENCY: Ep//-�%t T ��. �y/ y, <br /> ADDRESS: <br /> PHONE(1): z3 - PHONE(2): - 3$A�JUt�ZFAX OR E-MAIL: Z3��pS �_ <br /> Please allow 1D business days from date of application submittal for the records to be avallable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQl1E5T $139 FEE(CASH OR CHECK ONLY);REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,�p�j/j �(�y' Z�Z�. DATE1p—/q—/7 <br /> 1. List uo to ten addresses in the space below. Se1�1ct the type(sj of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to1209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted.Applications received after 3:110 pm will be processed the next business day. <br /> 2. For assistance In identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. / <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5;00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From r to <br /> ENVIRONMENTAL _ <br /> HH DE <br /> EALTPARTMENT FILE ADDRESS <br /> FILES <br /> EHD USE ONLY <br /> LNOERGROVND TANK(UST) Street# Street Name City <br /> CLEANUP SIM(LOP)• / ^/� ` CONSxMER 9OTHER CLEANUP Sim(NON-LOP) ❑ <br /> a-HAZARDOUS WASTE ^y/ ^ 1 V' 1 <br /> Q'TIERED PEAMRfED FACILITY 2 UO ( ` (r[JJ!//C ��(� � -Fw. 1( ISI7 ❑DARY <br /> WABOVEGROUND TANK UU V(I"✓"J LLJ 111 ✓✓✓YY, III �/_� <br /> UST(MONITORING I REMOVAL) ❑PWS. <br /> (�HAZAi1oOVS MATERUlS 2 <br /> 9SPILURELEASE RESPONSE <br /> ❑SOLID WASTE FACIUT'/VEHICLE 4 (WATER OVAUTY <br /> ❑FOOD FACIUW I CD d r w <br /> POOL/SPA �•v �1��� <br /> $ITE MIIIGgTON <br /> ONPY 5 <br /> El LPN.USE APPLICATION SITES <br /> E]SEPTIC PUMPER TRUCK/ HOVvxG <br /> 8 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMENT T CUPA <br /> ❑MOTEUHOTEL <br /> ❑CHICKEN RANCH 100.KENNEL CUPA-UST <br /> rl MEDICAL WASTE FACILITY 5 <br /> ❑TATT00/e00Y PIERCING <br /> n WASTE TIRE Cl S.U.WAsle <br /> �COMPLAINT B <br /> OrHER(PLEASE SPECIFY): <br /> to ❑AccoVNnxo <br /> ^'BOXED AREA-EHD IISE ONLY"' <br /> L ii, . ICL <br /> [0:Records provided by Staff-PPR Complete. stw N.m.: <br /> END 4e-05 <br /> Received Time Jun, 14. 2017 9: 35AM No. 1678 <br />